I. Pay attention to the mental health care work in the treatment of chronic diseases Patients with chronic diseases generally have psychological problems and psychological symptoms: such as unrealistic attitude toward the disease, pessimistic and disappointing emotions; such as insomnia, dizziness, gastrointestinal disorders, cardiovascular dysfunction and other functional physical symptoms and feelings of illness; some patients with chronic diseases are themselves “physical and mental diseases Some patients suffer from chronic diseases that are themselves “physical and mental diseases”, or even simple “mental diseases”. Strictly speaking, the symptoms of chronic diseases should include both physical and psychological aspects, both of which together constitute the “disease” as a whole. Because psychological symptoms can also cause pain to the patient, impair the patient’s quality of life, and affect the healing and regression of the disease, they should be regarded as part of the “chronic disease” and receive due attention and treatment. According to the new definition of health, the requirements are: physical – no disease; psychological – health; social function – good adaptation, interpersonal relationship coordination. 1, psychological health standards: (1) thinking can correctly reflect reality; (2) happy and stable emotions; (3) strong will; (4) sound personality; (5) interpersonal relations coordination. 2, psychologically healthy people: (1) realistic people: no guilt or remorse for past events. Of course, also admitted to have done wrong, but will not be so chagrin and worry; not worry about the future, that is a stupid way of life, must face reality, because people are living in the present rather than the past or the future; not afraid of the unknown world, like to explore everything, whenever you cherish the time in front of you. (2) pleasant people: rich sense of humor, know how to laugh, how to joke; not complaining, not complaining. (3) Open-minded people: open-minded, good with people, willing to suffer and let others, not worship idols. (4) ideal people: life has a pursuit, struggle has a goal, obey the law, not one-sided pursuit of personal interests. Third, the psychological disorders of patients with chronic diseases are mainly state of mind (emotional) problems What is state of mind, emotion, mood? Emotion: the subjective experience and attitude of individuals towards external things or the objective world, those who are suitable for their needs feel happy, those who are not feel unpleasant. Emotion: Mental excitement caused by physiological changes caused by something (motive), it is a mental process characterized by subjective experience, physiological changes and external behavioral manifestations, and is also called a specific form of emotional experience. State of mind: a comprehensive and persistent emotional state that prevails for a specific period of time, and in extremes can color a person’s feelings about the objective world significantly. Depression, anxiety, and exaltation are abnormal states of mind, while normal states of mind are characterized by stable emotions that are neither depressed and anxious nor high and excited. In everyday common usage, emotions, feelings and states of mind are sometimes confused and not distinguished. Emotion is the backbone of mental activity and the source of mental energy: positively, it gives people vitality and vigor, and drives them to pursue and practice what the Chinese call “essence and spirit”. It negatively affects one’s judgment and tends to stimulate blind impulsive behavior. Normal human emotional experience (CES-D): (1) I feel the same as others. (2) I feel that I have a future and hope. (3) I can feel happy. （Depression and anxiety are the main clinical manifestations of affective disorders. What is depression? Depressed mood (state of mind) is the main symptom, and the basic symptoms are: (1) lack of energy, (2) loss of interest and pleasure, and (3) indifference to human relationships. The psychological symptoms are: (1) thinking against the child, regret and guilt, self-condemnation and denial of one’s past; (2) loneliness and helplessness, shame and guilt, pessimism and pessimism, and life is like a year; (3) disappointment and despair, hopelessness, a bleak future, and the inability to see one’s future. The key symptom of a depressed state of mind is suicide, which must be raised awareness and closely guarded. (1) Are you still able to get pleasure from life? (Basic) (2) Are you interested in things as usual? (Basic) (3) Has your motivation weakened recently? (Basic) (4) Do you feel tired or have no energy during the day? (Basic) (5) Do you feel nervous, tense and impatient? (6) Do you feel indecisive? (Basic) (7) Do you have trouble sleeping? (Physical) (8) Do you feel any pain or tightness in your chest? (Physical) (9) Do you have a poor appetite and have you lost weight? (physiological) (10) Do you have difficulty with your sex life? (Physical) (Psychological) (11) Are you more worried than usual? (Psychological) (12) Do you feel that living is meaningless? (Psychological) What is anxiety? Anxiety is a state of nervousness and anxiety that is mainly expressed as apprehension, a “fear” emotion. Anxiety differs from fear in that anxiety is a feeling of insecurity of unknown or unexplained origin, always foreseeing an internal or external source of danger, misfortune, or even disaster, but the source of this danger is not clear; fear is a reaction to an external threat or danger of which one is clearly aware. Both anxiety and fear have the same manifestations: nervousness of movement, sympathetic hyperactivity, anxiety about the expected misfortune, anxiety, and anxiety. There is a distinction between “psychological anxiety” and “somatic anxiety” depending on whether the symptoms of anxiety are psychologically or physically dominant. The recurrent attacks of severe anxiety, accompanied by obvious vegetative symptoms, such as sudden manifestations: palpitations, chest tightness, choking feeling, dizziness, non-real feeling, near death feeling, feeling of uncontrollable madness, extreme fear, sweating and other psychological crisis states, are called “panic attacks”, each lasting for several minutes or even several hours. Anxiety self-assessment scale: (1) I feel more nervous and anxious than usual. (2) I feel scared for no reason. (3) I get easily upset or frightened. (4) I feel like I’m going crazy. (5) I have a premonition that something bad will happen. (6) My hands and feet tremble and shake. (7) I am distressed by head, neck and back pain. (8) I feel easily weakened and tired. (9) I feel unsettled and restless. (10) I feel panicky. (11) I am distressed because I often feel dizzy. (12) I have fainted or feel as if I am going to faint. (13) I feel short of breath in my chest and I can’t breathe enough. (14) I have numbness or tingling sensation in my hands and feet. (15) I often have to urinate. (16) I often have cold sweats on my hands and feet. (17) I often have a red and hot face. (18) I feel sick in my stomach and have indigestion. (19) I have trouble falling asleep and can’t sleep well all night. (20) I have nightmares. Fourth, the treatment of depression and anxiety The application of antidepressants The effective pharmacological treatment of depressed state of mind is a great achievement in the development of psychopharmacology in the last half century, which has relieved millions of people’s mental pain. There are many kinds of antidepressants available, some early and some late, some expensive and some cheap, and there is a huge difference, but the efficacy is comparable, generally can make 70% of patients get better remission, and so far are also in clinical use, please read the instructions and choose according to the actual situation of the patient. Current antidepressants include: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective 5-hydroxytryptamine reuptake blockers (SSRIs), and other varieties. Among them, TCAs are the representatives of old drugs, which have obvious atropine-like side effects, such as dry mouth, constipation, blurred vision and other discomforts, and are not suitable for patients with heart disease and glaucoma, etc. However, they are reliable and inexpensive, and have been used for nearly 50 years, and are generally acceptable to people; SSRIs are the representatives of new drugs, with five commonly used ones, which are known as “five golden flowers “easy to take, reliable efficacy, adapt to a wide range of side effects and discomfort, patients can take drugs while insisting on work, especially for the less depressed or elderly patients, the disadvantage is that the price of drugs is more expensive. (1) Doxepin, TCA, strong anxiolytic effect, suitable for depressed patients with nervousness and anxiety. 25mg/tablet, treatment amount: 150-300/day. (2) Amitriptyline, TCA, strong antidepressant effect, can improve sleep, for patients with heavy depression. 25mg/tablet, treatment amount: 150-300/day. (3) Chlorpromazine, TCA, strong driving and anti-compulsive effect, for depressed patients with marked depression and sluggishness or compulsive symptoms. 25mg/tablet, therapeutic amount: 150-300/day. (4) Fluoxetine, SSRI, strong driving effect, enhances vitality, improves initiative, suitable for depressed patients with drowsiness and depression, not suitable for those with significant insomnia and anxiety alone. 25mg/tablet, therapeutic dose 1-3 tablets/day. (5) Sertraline, SSRI, has both driving and anxiolytic effects, indicated for depressed patients who are depressed and anxious but can still sleep. 20mg/tablet, therapeutic dose 1-3 tablets/day. (6) Paroxetine, SSRI, has both sedative and anxiolytic effects, improves sleep, indicated for depressed patients with nervousness and restlessness but poor sleep. 20mg/tablet, therapeutic dose 1-3 tablets/day. (7) Xipomol, SSRI, has both driving and anxiolytic effects, moderate action, in vivo metabolism without hepatic microsomal enzyme P450, does not interact with general psychotropic drugs, suitable for depressed patients with somatic disorders. 20mg/tablet, therapeutic dose 1-3 tablets/day. (8) Fluvoxamine, SSRI, better anti-compulsive effect, for depressed patients with obsessive-compulsive disorder or marked obsessive-compulsive symptoms. 50mg/tablet, daily dose 2-6 tablets. Application of anxiolytic agents Benzodiazepines are the main drugs currently used in the treatment of anxiety, and have both sedative and hypnotic, muscle relaxing and anticonvulsant effects of varying severity. These drugs are generally safe to use, but they also have various side effects, and some varieties have caution and prohibition requirements, so it is recommended to read the instructions carefully before use. On the issue of dependence side effects should also pay due attention, but there is no need to choke, when used or not. (1) diazepam (Valium), oral absorption is faster, T1/2: 50-100hrs, commonly used for anti-anxiety and sedation and sleep, oral agent: 2.5mg/tablet, reasonable usage is the first week morning and afternoon each 1 tablet, 2 tablets at night before bedtime, a week later morning and afternoon discontinued, 2 tablets at night before bedtime continue to take. Injection 10mg/ml, 10-20mg each time, for sedation or sleeping, intravenous or intramuscular administration can be used, but intravenous administration is more effective. (2) Alprazolam (Jiajing Valium), orally absorbed quickly, T1/2: 12-15hrs anti-anxiety effect, sedation sleepy response is light, recommended to take during the day. 0.4mg/tablet, 1-4 tablets/time, 1-3 times/day. (3) Chlordiazepoxide (lorazepam, lorazepam), T1/2: 10-18hrs, similar to alprazolam, also often used during the day, 0.5mg/tablet, 1-2 tablets/dose, 1-3 times/day. (4) Eszopiclone (Scholastin), T1/2: 10-24hrs, sleeping effect is better than anti-anxiety, mostly used to assist sleep, 1mg per tablet, 1-2 tablets each time before bedtime. (5) Nitrazepam (nitrozepam), T1/2: 18-28hrs, used as a sleeping pill, 5mg/tablet, 1-2 tablets/night before bedtime. (6) Flurazepam (Fluazepam), T1/2: 48-100hrs, used as a sleeping pill, 15mg/tablet, 1-2 tablets/night before bed. (7) Clonazepam (Clonazepam), T1/2: 26-49hrs, mainly used to control various types of seizures. It has good sleeping and sedative effect. 2mg/tablet for oral dose, 1-2 tablets/time orally. Injection 1mg/ml, 1-4mg/dose, administered intravenously, is used to control agitated excitable patients. V. On the management of sleep problems , the staging of EEG activity of sleep: dreamless sleep and dreamy sleep; dreaming and sleep length problems. , types of insomnia: difficulty in falling asleep, dreamy and unsleeping, early awakening in the middle of the night. , rational selection of sleeping pills: identify the symptoms and choose the pills with the length and strength. Insomnia is only a symptom, not a disease, and should be treated at the root of the disease, so do not only treat the symptoms; sleeping pills certainly can not cure the disease, but the patient does not sleep any medicine to cure the disease is hardly effective.